Davidoff Andrew M, Fernandez-Pineda Israel, Santana Victor M, Shochat Stephen J
Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
Semin Pediatr Surg. 2012 Feb;21(1):88-99. doi: 10.1053/j.sempedsurg.2011.10.010.
Pediatric surgeons play a critical role in diagnosing, staging, and treating malignant solid tumors in children. Over the years, the surgical management of the primary tumor site has evolved from an aggressive en-bloc resection at diagnosis to a more tailored surgical approach, often affecting definitive local control after the delivery of neoadjuvant therapy, as currently directed by many solid tumor protocols. In fact, inappropriate upfront resection can lead to unnecessary short- and long-term morbidity, an incomplete resection, and may be associated with a delay in the initiation of the systemic chemotherapy that is critical to the treatment of gross or occult metastatic disease. Therefore, it is important for the pediatric surgeon, as a member of the multidisciplinary team involved in the care of these children, to understand the indications for and implications of neoadjuvant therapy in the treatment of pediatric solid tumors. Here we review the current management of childhood solid tumors focusing on the role of neoadjuvant therapy.
小儿外科医生在儿童恶性实体瘤的诊断、分期及治疗中发挥着关键作用。多年来，原发肿瘤部位的手术管理已从诊断时的积极整块切除演变为更具针对性的手术方法，这通常会影响新辅助治疗后的确定性局部控制，正如目前许多实体瘤治疗方案所指导的那样。事实上，不恰当的 upfront 切除可能导致不必要的短期和长期并发症、切除不完全，并且可能与对明显或隐匿性转移性疾病治疗至关重要的全身化疗开始延迟有关。因此，作为参与这些儿童护理的多学科团队成员，小儿外科医生了解新辅助治疗在儿童实体瘤治疗中的适应证及影响非常重要。在此，我们回顾儿童实体瘤的当前管理，重点关注新辅助治疗的作用。
